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Introduction and Objectives. Paraurethral Skene’s glands located in the lower third of the urethra secrete a fluid which serves to lubricate the urethra and has antiseptic value for the urethral meatus and vaginal introit. Skene’s gland abscess is rarely seen in common practice, with an unknown incidence. Materials and Methods. In this patient illness manifested itself brutally with vaginal pain, dysuria, and purulent leaks from the urethra. Surgical excision of the abscess was performed in spinal anesthesia after intravenous antibiotics trough anterior vaginal approach. Bleeding was minimal, no others intraoperative complications and postoperative recovery was simple. Bladder drainage was provided during the surgical procedure and postoperatively by an 18 Fr Foley catheter. Results. One year after the intervention, there is no local relapse and micturition is easy, the patient being continent. The histopathological examination completed the preoperative diagnosis and allowed identification of the patho)genesis in this case. Conclusions. The U-transvaginal flap technique is a technique that allows complete ablation, is less traumatic and allows early and fast recovery. To prevent surgical complications in the postoperative period, it is necessary to have a team of professionals involved in such interventions as well as special equipment with specific instruments; in this sense, we mention the knowledge of the anatomical relations between the urethral wall and the vaginal wall. [ABSTRACT FROM AUTHOR]

Objectives: To report our urethral surveillance programme and urethral cancer recurrence rate following radical cystoprostatectomy (RC). Patients and methods: A retrospective analysis of clinical and histopathological data of men who underwent RC and urethral surveillance, between January 2011 and October 2016. Results: RC was performed for 491 men; 31 and 19 men had a synchronous (malignancy, n = 10, 32.3%) and interval (malignancy, n = 6, 31.6%) urethrectomy, respectively. The remaining 441 men underwent surveillance; 183 (41.5%) men had at least one urethroscopy, 14 (3.2%) urethrectomies were performed and 12 (2.7%) specimens confirmed urethral recurrence (UR). Within the URs, 7/12 (58.3%) men presented symptomatically and 5/12 (41.7%) were detected through surveillance. At a median (interquartile range) follow-up of 21.8 (9.7–36.7) months, the 2-year disease-specific survival in men who had synchronous urethrectomy was 71.4% (versus no urethrectomy (84.6%) interval urethrectomy (92.9%) and urethrectomy for recurrence (83.8%)). Conclusion: UR following RC is low in men without risk factors for urethral disease. Annual urethroscopy and urine cytology may not be feasible and appropriate in all men after RC, and does not appear to impact survival at 2 years. A risk-adapted approach may allow the avoidance of annual urethroscopy in asymptomatic men post RC. Level of Evidence: 3b [ABSTRACT FROM AUTHOR]

Abstract: Objective: To investigate the clinical and radiological parameters of posterior urethral valve (PUV) patients with residual valve or strictures after primary valve ablation. Patients and methods: A total of 127 PUV patients were treated in our clinic between 1986 and 2009. We retrospectively reviewed the records of 101 patients, who had at least 1 year of follow-up data, regarding the presence of valve remnants or urethral strictures after PUV ablation. Results: A total of 21 patients (20.8%) underwent repeat-urethroscopy and, of these, residual valve leaflets or stricture were detected in 10 patients (10/101, 9.9%). In 2 of these 10 (20%), the urethra had been found to be normal on the first voiding cystourethrogram following ablation. However, these two boys underwent re-urethroscopy due to persistent vesicoureteral reflux in one and persistent hydroureteronephrosis in the other, and valve remnants were detected. The remaining 8 cases had radiological signs consistent with persistent infravesical obstruction in the early period. Obstruction was due to urethral stricture and residual valve remnants in 2 and 6 cases, respectively. Conclusions: There was clinical suspicion of residual valve in about 20% of the cases and in half of these the urethra was found to be normal on urethroscopy. The possible presence of residual valve remnants after primary valve ablation should be confirmed by careful clinical, radiological and endoscopic evaluation. [Copyright &y& Elsevier]

The article focuses on the use of diagnostic flexible cysto-urethroscopy (FC) to investigate various symptoms including haematuria, lower urinary tract symptoms, (LUTS) and urinary tract infections in Great Britain. A study is conducted to examine if FC offers useful diagnostic information in young patients investigated for urological symptoms. It provides information regarding the results of the study.

Purpose: We analyzed studies validating the effectiveness and deficiencies of simulation for training and assessment in urology. We documented simulation types (synthetic, virtual reality and animal models), participant experience level and tasks performed. The feasibility, validity, cost-effectiveness, reliability and educational impact of the simulators were also evaluated. Materials and Methods: The MEDLINE®, EMBASE™ and PsycINFO® databases were systematically searched until September 2010. References from retrieved articles were reviewed to broaden the search. Results: The study included case reports, case series and empirical studies of training and assessment in urology using procedural simulation. The model name, training tasks, participant level, training duration and evaluation scoring were extracted from each study. We also extracted data on face, content and construct validity. Most studies suitably addressed content, construct and face validation as well as the feasibility, educational impact and cost-effectiveness of simulation models. Synthetic, animal and virtual reality models were demonstrated to be effective training and assessment tools for junior trainees. Few investigators looked at the transferability of skills from simulation to real patients. Conclusions: Current simulation models are valid and reliable for the initial phase of training and assessment. For advanced and specialist level skill acquisition animal models can be used but availability is limited due to supply shortages and ethical restrictions. More research is needed to validate simulated environments for senior trainees and specialists. [ABSTRACT FROM AUTHOR]

Purpose: Urethral stricture is the second most common complication of hypospadias repair after urethrocutaneous fistula. Usually more than 1 procedure is needed for correction due to a lack of available tissue after previous repairs. We evaluated 1-stage urethral stricture management after hypospadias repair using a ventral buccal mucosal graft. We describe the importance of graft hanging and coverage. Materials and Methods: From August 2004 to April 2009, 15 patients 9 to 17 years old underwent urethral stricture repair after failed hypospadias surgery. Mean time after primary surgery was 7.2 years (range 4 to 13). Vascularized periurethral tissue around the stenotic part of the neourethra was dissected. The urethra was opened ventrally and a buccal mucosal graft of appropriate size was inserted to allow urethral augmentation. Using several U stitches the graft was anchored to the surrounding periurethral tissue to prevent its folding and retraction. Recurrent chordee in 12 patients and secondary vesicoureteral reflux in 3 were also corrected at this time. Results: Mean followup was 37 months (range 17 to 73). Successful results were confirmed in all patients by urethrography and uroflowmetry. One urethral fistula was corrected 3 months later by minor surgery. Recurvature did not develop in this group. There was no recurrent reflux in endoscopically treated patients. Conclusions: Ventral buccal mucosal grafting is a simple, safe option for urethral stricture repair. Hanging the graft to periurethral tissue is important for its survival and to prevent postoperative folding and retraction. [ABSTRACT FROM AUTHOR]

Purpose: In neonates with a posterior urethral valve serum creatinine is increased. It decreases after successful relief of obstruction. Clinicians consider urinary diversion if serum creatinine remains increased. However, the optimal rate of decrease of serum creatinine is not defined. We generated useful data on the rate of serum creatinine decrease in neonates with a posterior urethral valve by introducing the idea of a prediction curve. Materials and Methods: We reviewed the medical charts of 15 consecutive children treated for a posterior urethral valve in the neonatal period at our institute between 2002 and 2007. The 11 children with a delayed diagnosis of a posterior urethral valve were excluded from analysis. Serial serum creatinine levels in the cohort of 15 patients were analyzed to estimate 1) the rate of decrease after valve ablation and 2) the time needed to achieve a nadir. Results: One child died of renal insufficiency on day 10 of life and was excluded from study. Serum creatinine attained a nadir at about age 6 months but 73% of the total decrease occurred within the first 2 months of life, which was also equal to a 45% decrease from the peak values recorded soon after birth. The rate of decrease did not appear to be influenced by the peak values. Children with normal peak creatinine or intercurrent problems did not follow the trend. Conclusions: The rate of decrease in serum creatinine in the first few months of life may provide useful information on the adequacy of valve ablation. [ABSTRACT FROM AUTHOR]

Abstract: Objective: We report additional technical modifications and extended application of proximal TIP hypospadias repair in consecutive patients operated by a single surgeon. Materials: During a 39-month period, 36 patients underwent primary proximal hypospadias surgery, with 26 undergoing TIP and 10 two-stage repair for a thin urethral plate (UP) (1) or ventral penile curvature (VC) requiring UP transection (9). Of the TIP repairs, 16 had UP elevation from the corpora cavernosa to facilitate VC straightening while maintaining the UP for urethroplasty. All TIP patients underwent two-layer urethroplasty with tunica vaginalis coverage over the neourethra. Results: With mean follow up of 12 months (2–38) in 24 TIP patients, 16 had calibration and 11 urethroscopy 6–12 months postoperatively. Complications occurred in three (13%), glans dehiscence (2) and neourethral stricture (1), which represents a significant reduction versus our prior reports. Non-randomized preoperative testosterone in 8/24 with follow up did not influence complication rates. TIP incision of the elevated UP did not divide it into separate strips, or impair vascularity. Conclusions: Dissection of the UP from the corpora facilitates correction of VC while preserving the plate, without increasing TIP urethroplasty complications. Overall, complication rates for TIP have significantly diminished with technical modifications and experience. The role for neoadjuvant hormonal therapy remains unclear. Despite straightening VC preserving the UP, intraoperative assessment deemed it unsuitable for TIP in one case (4%). [ABSTRACT FROM AUTHOR]

Abstract: Objective: To establish an experimental model of urethral stricture in rabbits. Methods: A total of 21 adult male New Zealand rabbits were included into group. After intravenous anesthesia, urethroscopy was performed with a pediatric resectoscope (F13). Fifteen animals were randomly selected as the study group. A 1cm-long circumferential electrocoagulation of the bulbar urethra was performed to these animals until ulceration of the mucosa. The remaining 6 animals underwent video urethroscopy without electrocoagulation, serving as controls. On the 30th day, retrograde urethrogram and urethroscopy were performed to evaluate urethral stricture formation, histological examinations (HE and Sirius Red staining) were done to assess urethral pathological change. Results: Two rabbits in study group died and no death occurred in controls. Based on urethrogram and urethroscopy, no rabbits in control group developed urethral stricture, while significant stricture formation was observed in every case of the study group. Histological examination showed a normal urethra in control cases, while at stricture site of the study group extensive fibrosis of muscle and submucous tissue was observed with a large number of fibroblasts infiltration. High collagen expression in fibrosis tissue was assayed by Sirius Red staining. Conclusion: A 1cm-long endoscopic electrocoagulation can successfully induce urethral stricture formation in rabbit models. This method offers an ideal animal model for the fundamental and clinical study of urethral stricture. [ABSTRACT FROM AUTHOR]

Objective: To evaluate efficacy of “U” shaped prostatobulbar anastamosis [USPBA] in a posterior urethral stricture along with its urethroscopic evaluation to let us assess the process of neourethrisation in successful cases as well as pathogenesis of restricture in failure cases. Methods: We analysed results of “U” shaped prostato-bulbar anastamosis in 132 patients with posterior urethral stricture, preoperatively and postoperatively with a retrograde urethrogram, urethrosonogram, uroflowmetry and patient satisfaction (based on symptoms). With comparative analysis, results were categorised as good, fair and poor. Twenty patients were randomly selected for urethroscopic evaluation to directly visualise the anastomotic site. Results: Good and fair results were counted as successful. On immediate postoperative evaluation the success rate was 96.2%, which remained almost the same at 6 months but decreased to 92.42% at 12 months and 90.9% at 24 months. Urethroscopy showed mucosal covering at the area of the roof of neourethra in patients having good results with patent and distensible lumen. Cases with fair results showed similar findings except for some narrowing at places and mucosal irregularities. Poor result cases mostly showed dense fibrosis with collapsed lumen or circumferential scarring leading to constricting stricture. Conclusion: USPBA lacks disadvantages of ring anastamosis and is an effective option for posterior urethral strictures. [Copyright &y& Elsevier]

Abstract: Here we present a case of successful non-operative management of an iatrogenic recto-urethral fistula in a 13-year-old boy. The fistula was created when urethroscopic repair of a urethral stricture was attempted. Due to the anatomy of the lesion and previous urinary diversion, it was deemed possible to spare this patient diverting colostomy or surgical repair of the fistula. The result was successful closure of the fistula, which was confirmed on retrograde urethrogram. While we do not support the routine use of non-operative management for recto-urethral fistulas we have demonstrated that there are circumstances where it can be safely applied. [Copyright &y& Elsevier]

Abstract: Urethral hair and diverticula are well described long-term complications following urethroplasty or hypospadias repair. Endoscopic laser ablation is an uncommonly reported treatment option for a symptomatic hair-bearing urethra, and holmium laser hair epilation has not been previously reported in the literature. We report the first case of urethroscopic holmium laser ablation of urethral diverticular hair follicles and the outcome. [Copyright &y& Elsevier]

Purpose: Prostatic utricle comes from an incomplete regression of the MÜllerian structures. Only those that are symptomatics presenting UTI or incontinence, should be considered for surgery. We present our experience with the laparoscopic approach for prostatic utricle resection in 5 patients with a mean age of 9.5 y.o (5-16). Material and Methods: The procedure begins with a cystourethroscopy and catheterization of the utricle with a Fogharty or a cystoscope, that is left inside the prostatic utricle to facilitate subsequent identification and mobilization during the procedure. Laparoscopy was conducted via a 10 mm port inserted through an umbilical incision. Two more 5 mm working ports were inserted at the right and left mid-abdomen. Resection of the utricle is done by electric monopolar cautery hook. Results: In all five boys resection was satisfactory except in one case that needed open conversion due to bleeding. Mean operative time was 165 min (120-240). Conclusions: Laparoscopic resection is a minimally invasive approach and cystocopy offers a good help and safe dissection of the utricule. [Copyright &y& Elsevier]

Purpose: Urethral duplication is a rare congenital anomaly. We report the clinical presentation, imaging findings and surgical treatment in a patient with Y-type duplicated urethra. Material and Methods: 2 years old boy presented to our clinic with voiding through his anus and urine dribbling from the urethral meatus at the center of the glans. He had an urethral meatus and a second anal urinary meatus on physical examination . Retrograde and voiding cystourethrograms and cystourethroscopy showed the Y-type urethral duplication with stenosis of the dorsal orthotopic urethra and a ventral dominat urethra placed in the anal opening that was functionally normal. The patient was treated with 2-stage urethral reconstruction. At first, ventral dominant anal urethra was transposed to the perineum followed by urethroplasty 6 months later. Proximal to distal steps of the urethroplasty were; 2 cm penile skin tubularization, 4cm preputial island flap tubularization, marsupialization of the dorsal orthotopic urethra, 2cm preputial inlay grefting between the incised dorsal urethral plate, preputial onlay flap to augment the dorsal urethral plate and finally tubularization of all parts to form ‘Thiersch type’ neourethra. Results: After 1 year of follow-up, no urethrocutaneous fistula developed and the patient now voids spontaneously through a meatus located normally at the tip of the glans. Conclusions: While the ideal surgical management of urethral duplication anomalies remains uncertain, we used a combination of surgical techniques to correct this severe malformation. [Copyright &y& Elsevier]

Purpose: It might be diffucult to evaluate the clinically significant residual valve remnants and strictures, and make a judgement for the re-operation after the ablation of posterior urethral valve. In this research, clinical and radiological parameters are examined in cases with residual valve remnants. Material and Methods: Between 1986-2009, a total of 127 valve patients were treated in our clinic and the records of 101 patients, who had regular follow-up, were included to the study. Of these 101 children, the records of 10 patients, who were found to have residual valve or stricture after ablation, were reviewed retrospectively. Results: Endoscopic intervention due to the residual valve remnants or stricture was performed after a mean period of 7.25±4.7 months following the first ablations. In 2 (20%) of the cases, urethra has been found to be normal in the first radiological evaluation (voiding cystourethrography). Of these 2 children, urethroscopy was conducted due to the recognition of the valve remnants in the follow-up of vesicoureteral reflux in one case and during evaluation of persistent hydroureteronephrosis in the other case. Two out of 8 cases who had the radiological appearance of obstruction in the early period, were found to have strictures. In the other 6 cases, the residual valve remnants were incisized. In the follow-up, endoscopy was re-conducted on the 2 out of 8 cases due to strictures. Conclusions: In our series, almost 10% of the cases were found to have residual valve or strictures. Although about one fifth of the cases were seen to be normal in the first radiological examination, valve remnants were found in the clinical follow-up evaluations due to the persistent hydrourethronephrosis and vesicoureteral reflux. For this reason, the operation decision should be given in the light of the clinical and radiological evaluations together to find the significant valve remnants and strictures following valve ablation. [Copyright &y& Elsevier]

Purpose: Judging the significance of valve remnants at check cystourethroscopy after ablation of posterior urethral valves (PUV) can be difficult. In November 2006, our Department adopted a policy of performing a repeat micturating cystourethrogram (MCUG) prior to check cystourethroscopy three months after primary PUV ablation. The aim of this study is to determine the predictive value of repeat MCUG for further valve resection at check cystourethroscopy. Material and Methods: We retrospectively reviewed the operative notes and MCUG (performed by Consultant Paediatric Radiologists) of all 31 boys with PUV who had a check cystourethroscopy with pre-operative MCUG between November 2006 and October 2008. Results: Repeat MCUG indicated remnant valves in ten boys, but no residual leaflets could be identified at subsequent endoscopy in four. In 21 boys, the PUV appeared completely ablated on MCUG. However, on cystourethroscopy, valve leaflets thought to necessitate resection were present in nine. Taking the degree of persistent posterior urethral dilatation on MCUG into consideration did not improve the test''s ability to anticipate residual valve leaflets at check cystourethroscopy. The positive predictive value of repeat MCUG for subsequent resection of valve remnants is 60%; the negative predictive value is 57%. Conclusions: Repeat MCUG after primary PUV ablation portends further resection of valve remnants at subsequent check cystourethroscopy in only 60%. Importantly, where complete PUV ablation is shown radiologically, remnant leaflets deemed significant are found on endoscopy in 43%. We recommend check cystourethroscopy three months after PUV ablation; pre-operative repeat MCUG is unprofitable. [Copyright &y& Elsevier]

Abstract: Association of the anterior and posterior urethral valve is a rare congenital anomaly which can lead to various urinary tract symptoms. An 8-year-old boy was referred by his primary care physician for urinary dribbling, straining at micturition, and recurrent febrile urinary tract infection since the age of 2 years. Clinically, the bladder was palpable; both testes were normal, and, in addition, he had a subcoronal hypospadias. Diagnosis was confirmed by retrograde urethrogram and voiding cystourethrogram (micturating cystourethrogram) and urethroscopy. Cystoscopic ablation of both valves was done by electrocautery hook using low current at 5 o''clock and 7 o''clock directions. He voided with good flow and to completion. Urinary dribbling had completely subsided and renal function was normal at a follow-up period of 36 months with freedom from recurrent urinary tract infection. Both the anterior and posterior urethral valves develop from different embryological sources; thus, this association is rare. A case with this association has not been reported previously in the literature. [Copyright &y& Elsevier]